ALICE PECK DAY MEMORIAL HOSPITAL: Form 990, tax year 2018

View the entire original 990 at ProPublica ↗

Organization: ALICE PECK DAY MEMORIAL HOSPITAL (EIN 02-0222791)
Tax period: 2018-07-01 to 2019-06-30
Filed: 2020-07-15
IRS object ID: 202031979349303378
Schema version: 2018v3.2
Source: Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header
Form 990
Schedule A
Schedule B
Schedule C
Schedule D
Schedule H
Schedule I
Schedule J
Schedule K
Schedule L
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2020-07-15T12:18:18-05:00	ReturnTs
Tax Period End	2019-06-30	TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Field	Value	IRS element (for citing)
Preparer Firm EIN	010494526	PreparerFirmEIN

Preparer Firm Name PreparerFirmName

Field	Value	IRS element (for citing)
Business Name Line1	BAKER NEWMAN & NOYES LLC	BusinessNameLine1Txt

Preparer US Address PreparerUSAddress

Field	Value	IRS element (for citing)
Address Line1	650 ELM STREET SUITE 302	AddressLine1Txt
City	MANCHESTER	CityNm
State Abbreviation	NH	StateAbbreviationCd
ZIP	03101	ZIPCd

Field	Value	IRS element (for citing)
Return Type	990	ReturnTypeCd
Tax Period Begin	2018-07-01	TaxPeriodBeginDt

Filer Filer

Field	Value	IRS element (for citing)
EIN	020222791	EIN

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	Alice Peck Day Memorial Hospital	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Business Name Control	ALIC	BusinessNameControlTxt
Phone	6034483121	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	10 Alice Peck Day Drive	AddressLine1Txt
City	Lebanon	CityNm
State Abbreviation	NH	StateAbbreviationCd
ZIP	03766	ZIPCd

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	Susan E Mooney MD MS	PersonNm
Person Title	President & CEO	PersonTitleTxt
Phone	6034483121	PhoneNum
Signature	2020-07-14	SignatureDt
Discuss With Paid Preparer	Yes (1)	DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

Field	Value	IRS element (for citing)
Preparer Person	Nicholas E Porto	PreparerPersonNm
PTIN	P01310283	PTIN
Phone	8002447444	PhoneNum
Preparation	2020-07-14	PreparationDt

Filing Security Information FilingSecurityInformation

IP Address IPAddress

Field	Value	IRS element (for citing)
I Pv4 Address	208.105.168.164	IPv4AddressTxt

Field	Value	IRS element (for citing)
IP	2020-07-14	IPDt
IP Tm	10:03:08	IPTm
IP Timezone	ED	IPTimezoneCd
Filing License Type	P	FilingLicenseTypeCd
At Submission Creation Device Id	3452BD8595D9AC820B41F271E29CE8BF50AD3EDC	AtSubmissionCreationDeviceId
At Submission Filing Device Id	DA1D1F22D002DE74304CAE64996AD19EA354FE22	AtSubmissionFilingDeviceId

Field	Value	IRS element (for citing)
Tax	2018	TaxYr
Build TS	2020-09-23 17:36:50Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Principal Officer	Susan E Mooney MD MS	PrincipalOfficerNm

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	10 Alice Peck Day Drive	AddressLine1Txt
City	Lebanon	CityNm
State Abbreviation	NH	StateAbbreviationCd
ZIP	03766	ZIPCd

Field	Value	IRS element (for citing)
Gross Receipts	$74,909,011	GrossReceiptsAmt
Group Return For Affiliates	0	GroupReturnForAffiliatesInd
Organization501c3	Yes (X)	Organization501c3Ind
Website Address	www.alicepeckday.org	WebsiteAddressTxt
Type Of Organization Corp	Yes (X)	TypeOfOrganizationCorpInd
Formation	1943	FormationYr
Legal Domicile State	NH	LegalDomicileStateCd
Activity Or Mission	To improve the health and wellbeing of our community	ActivityOrMissionDesc
Voting Members Governing Body	21	VotingMembersGoverningBodyCnt
Voting Members Independent	13	VotingMembersIndependentCnt
Total Employee	576	TotalEmployeeCnt
Total Volunteers	70	TotalVolunteersCnt
Total Gross UBI	$26	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	$0	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$1,105,059	PYContributionsGrantsAmt
CY Contributions Grants	$682,127	CYContributionsGrantsAmt
PY Program Service Revenue	$70,526,144	PYProgramServiceRevenueAmt
CY Program Service Revenue	$73,224,665	CYProgramServiceRevenueAmt
PY Investment Income	-$58,871	PYInvestmentIncomeAmt
CY Investment Income	$1,015,717	CYInvestmentIncomeAmt
PY Other Revenue	$29,303	PYOtherRevenueAmt
CY Other Revenue	-$13,498	CYOtherRevenueAmt
PY Total Revenue	$71,601,635	PYTotalRevenueAmt
CY Total Revenue	$74,909,011	CYTotalRevenueAmt
PY Grants And Similar Paid	$41,972	PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid	$220,565	CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members	$0	PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members	$0	CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid	$36,709,910	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$43,750,730	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$0	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$212,314	CYTotalFundraisingExpenseAmt
PY Other Expenses	$32,554,938	PYOtherExpensesAmt
CY Other Expenses	$32,013,891	CYOtherExpensesAmt
PY Total Expenses	$69,306,820	PYTotalExpensesAmt
CY Total Expenses	$75,985,186	CYTotalExpensesAmt
PY Revenues Less Expenses	$2,294,815	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	-$1,076,175	CYRevenuesLessExpensesAmt
Total Assets BOY	$60,180,132	TotalAssetsBOYAmt
Total Assets EOY	$76,398,452	TotalAssetsEOYAmt
Total Liabilities BOY	$38,514,635	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$47,949,645	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$21,665,497	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$28,448,807	NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part III	Yes (X)	InfoInScheduleOPartIIIInd
Mission	To improve the health and wellbeing of our community	MissionDesc
Significant New Program Srvc	0	SignificantNewProgramSrvcInd
Significant Change	Yes (1)	SignificantChangeInd
Expense	$71,171,617	ExpenseAmt
Grant	$220,565	GrantAmt
Revenue	$73,224,665	RevenueAmt
Desc	Alice Peck Day Memorial Hospital is a community-based critical access hospital operating in Lebanon, NH. The Hospital began as a small cottage hospital in 1932. From its humble beginnings, Alice Peck Day has continually demonstrated its commitment to provide patient-focused health care services which improve the quality of life within its community and promote wellness for all. Alice Peck Day Memorial Hospital is a charitable health care organization which is dedicated to serving its community. This commitment includes granting credit to patients, substantially all of whom are local residents. The Hospital provides care to patients who meet certain criteria under its charity care policy without charge or at amounts less than the established rates. Collections are not pursued for amounts determined to qualify as charity care. The Hospital maintains records to identify and monitor the level of charity care it provides. These records include the amount of charges foregone for services and supplies furnished under its charity care policy, the established costs of the services and supplies provided, and equivalent service statistics. For the fiscal year ended June 30, 2019, charity care at a cost of $323,389 was provided to eligible patients. Estimated costs incurred in excess of payment for inpatient and outpatient services for Medicaid patients in fiscal year ended June 30, 2019 were $2,024,779. In addition to the charity care services described above, the Hospital provided a number of other services for which little or no payment was received. These included: the Upper Valley Smiles dental program of free oral health education, screenings, and preventive treatment offered to low-income children in ten local elementary schools; Elder Friends, a program matching volunteers one-on-one with isolated, home-bound seniors; Lebanon Lunch Friends, which provides 140 free lunches per day, five days each week to eligible local children who no longer have access to free or reduced-price meals at school during the summer; the Tobacco 21 initiative, which involved forming a community coalition to consider supporting a City of Lebanon ordinance that would restrict tobacco and e-cigarette sales to individuals 21 years and older. As a local hospital, Alice Peck Day works closely with community organizations to address community needs. Organizations that were beneficiaries of hospital staff time, meeting space, cash and/or materials included: Alcoholics Anonymous, American Red Cross, Good Neighbor Health Clinic, Headrest, Hanover Chamber of Commerce, Lebanon Chamber of Commerce, Lebanon School District, Lebanon Department of Recreation, the Upper Valley Public Health Council, and Vital Communities. In certain instances, assistance was provided to the community for which no value can be placed. This assistance included leadership in identifying community needs, staff commitment to volunteer for community organizations, and advocacy and support for individuals affected by the social determinants of health. Alice Peck Day considers caring for our community a special responsibility that we are honored to fulfill.	Desc
Total Program Service Expenses	$71,171,617	TotalProgramServiceExpensesAmt
Described In Section501c3	Yes (1)	DescribedInSection501c3Ind
Schedule B Required	Yes (1)	ScheduleBRequiredInd
Political Campaign Acty	0	PoliticalCampaignActyInd
Lobbying Activities	Yes (1)	LobbyingActivitiesInd
Subject To Proxy Tax	0	SubjectToProxyTaxInd
Donor Advised Fund	0	DonorAdvisedFundInd
Conservation Easements	0	ConservationEasementsInd
Collections Of Art	0	CollectionsOfArtInd
Credit Counseling	0	CreditCounselingInd
Temp Or Permanent Endowments	Yes (1)	TempOrPermanentEndowmentsInd
Report Land Building Equipment	Yes (1)	ReportLandBuildingEquipmentInd
Report Investments Other Sec	Yes (1)	ReportInvestmentsOtherSecInd
Report Program Related Invst	0	ReportProgramRelatedInvstInd
Report Other Assets	0	ReportOtherAssetsInd
Report Other Liabilities	Yes (1)	ReportOtherLiabilitiesInd
Include FIN48 Footnote	Yes (1)	IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt	0	IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt	Yes (1)	ConsolidatedAuditFinclStmtInd
School Operating	0	SchoolOperatingInd
Foreign Office	0	ForeignOfficeInd
Foreign Activities	0	ForeignActivitiesInd
More Than5000 K To Org	0	MoreThan5000KToOrgInd
More Than5000 K To Individuals	0	MoreThan5000KToIndividualsInd
Professional Fundraising	0	ProfessionalFundraisingInd
Fundraising Activities	0	FundraisingActivitiesInd
Gaming Activities	0	GamingActivitiesInd
Operate Hospital	Yes (1)	OperateHospitalInd
Audited Financial Stmt Att	Yes (1)	AuditedFinancialStmtAttInd
Grants To Organizations	Yes (1)	GrantsToOrganizationsInd
Grants To Individuals	Yes (1)	GrantsToIndividualsInd
Schedule J Required	Yes (1)	ScheduleJRequiredInd
Tax Exempt Bonds	Yes (1)	TaxExemptBondsInd
Invest Tax Exempt Bonds	0	InvestTaxExemptBondsInd
Escrow Account	0	EscrowAccountInd
On Behalf Of Issuer	0	OnBehalfOfIssuerInd
Engaged In Excess Benefit Trans	0	EngagedInExcessBenefitTransInd
PY Excess Benefit Trans	0	PYExcessBenefitTransInd
Loan Outstanding	0	LoanOutstandingInd
Grant To Related Person	0	GrantToRelatedPersonInd
Business Rln With Org Mem	0	BusinessRlnWithOrgMemInd
Business Rln With Fam Mem	0	BusinessRlnWithFamMemInd
Business Rln With Officer Ent	Yes (1)	BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri	0	DeductibleNonCashContriInd
Deductible Art Contribution	0	DeductibleArtContributionInd
Terminate Operations	0	TerminateOperationsInd
Partial Liquidation	0	PartialLiquidationInd
Disregarded Entity	0	DisregardedEntityInd
Related Entity	Yes (1)	RelatedEntityInd
Related Organization Ctrl Ent	Yes (1)	RelatedOrganizationCtrlEntInd
Transaction With Control Ent	Yes (1)	TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org	0	TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp	0	ActivitiesConductedPrtshpInd
Schedule O Required	Yes (1)	ScheduleORequiredInd
Info In Schedule O Part V	Yes (X)	InfoInScheduleOPartVInd
IRP Document	104	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Backup Wthld Compliance	Yes (1)	BackupWthldComplianceInd
Employee	576	EmployeeCnt
Employment Tax Returns Filed	Yes (1)	EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit	0	UnrelatedBusIncmOverLimitInd
Foreign Financial Account	0	ForeignFinancialAccountInd
Prohibited Tax Shelter Trans	0	ProhibitedTaxShelterTransInd
Taxable Party Notification	0	TaxablePartyNotificationInd
Nondeductible Contributions	0	NondeductibleContributionsInd
Quid Pro Quo Contributions	0	QuidProQuoContributionsInd
Form8282 Property Disposed Of	0	Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct	0	RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct	0	PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services	0	IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt	0	SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc	0	SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VI	Yes (X)	InfoInScheduleOPartVIInd
Governing Body Voting Members	21	GoverningBodyVotingMembersCnt
Independent Voting Member	13	IndependentVotingMemberCnt
Family Or Business Rln	0	FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties	Yes (1)	DelegationOfMgmtDutiesInd
Change To Org Documents	0	ChangeToOrgDocumentsInd
Material Diversion Or Misuse	0	MaterialDiversionOrMisuseInd
Members Or Stockholders	Yes (1)	MembersOrStockholdersInd
Election Of Board Members	Yes (1)	ElectionOfBoardMembersInd
Decisions Subject To Approva	Yes (1)	DecisionsSubjectToApprovaInd
Minutes Of Governing Body	Yes (1)	MinutesOfGoverningBodyInd
Minutes Of Committees	Yes (1)	MinutesOfCommitteesInd
Officer Mailing Address	0	OfficerMailingAddressInd
Local Chapters	0	LocalChaptersInd
Form990 Provided To Gvrn Body	Yes (1)	Form990ProvidedToGvrnBodyInd
Conflict Of Interest Policy	Yes (1)	ConflictOfInterestPolicyInd
Annual Disclosure Covered Prsn	Yes (1)	AnnualDisclosureCoveredPrsnInd
Regular Monitoring Enfrc	Yes (1)	RegularMonitoringEnfrcInd
Whistleblower Policy	Yes (1)	WhistleblowerPolicyInd
Document Retention Policy	Yes (1)	DocumentRetentionPolicyInd
Compensation Process CEO	Yes (1)	CompensationProcessCEOInd
Compensation Process Other	Yes (1)	CompensationProcessOtherInd
Investment In Joint Venture	0	InvestmentInJointVentureInd
States Where Copy Of Return Is Fld	NH	StatesWhereCopyOfReturnIsFldCd
Own Website	Yes (X)	OwnWebsiteInd
Upon Request	Yes (X)	UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	Todd Roberts	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Phone	6034483121	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	10 Alice Peck Day Drive	AddressLine1Txt
City	Lebanon	CityNm
State Abbreviation	NH	StateAbbreviationCd
ZIP	03766	ZIPCd

Field	Value	IRS element (for citing)
Info In Schedule O Part VII	Yes (X)	InfoInScheduleOPartVIIInd

Form990 Part VII Section A Form990PartVIISectionAGrp (33 entries)

TitleTitleTxt	Average Hours Per WeekAverageHoursPerWeekRt	Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt	Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd	Reportable Comp From OrgReportableCompFromOrgAmt	Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt	Other CompensationOtherCompensationAmt	OfficerOfficerInd	Highest Compensated EmployeeHighestCompensatedEmployeeInd
Clayton R Adams
Trustee	1.00	0.00	Yes (X)	$0	$0	$0
George T Blike
Trustee	1.00	40.00	Yes (X)	$0	$488,454	$89,309
Rebecca W Holcombe
Trustee	1.00	0.00	Yes (X)	$0	$0	$0
John P Houde MD
Trustee; Orthopaedic Surgeon	40.00	0.00	Yes (X)	$516,460	$0	$47,438
Patrick F Jordan
Trustee	1.00	40.00	Yes (X)	$0	$595,188	$58,364
Lisa Kettering
Trustee (end 6/19)	1.00	0.00	Yes (X)	$0	$0	$0
Sara L Kobylenski
Trustee	1.00	1.00	Yes (X)	$0	$0	$0
Michael T Lynch
Trustee	1.00	0.00	Yes (X)	$0	$0	$0
Anne D MacEwan
Trustee	1.00	2.00	Yes (X)	$0	$0	$0
Mark E Melendy
Trustee (end 12/18)	1.00	4.00	Yes (X)	$0	$0	$0
Edward J Merrens
Trustee (end 12/18)	1.00	40.00	Yes (X)	$0	$710,556	$48,934
Tina E Naimie
Trustee	1.00	40.00	Yes (X)	$0	$257,299	$28,591
Mary M Oseid
Trustee	1.00	40.00	Yes (X)	$0	$276,886	$60,259
Scott W Rodi
Trustee	1.00	40.00	Yes (X)	$0	$332,446	$60,374
John L Scherding
Trustee	1.00	1.00	Yes (X)	$0	$0	$0
Jennifer Sage Schiffman
Trustee	1.00	0.00	Yes (X)	$0	$0	$0
Charles J Wheelan
Trustee	1.00	0.00	Yes (X)	$0	$0	$0
Greg W Lange
Chair	2.00	0.00	Yes (X)	$0	$0	$0	Yes (X)
Marisa D Devlin
Vice Chair (beg 1/19)	2.00	0.00	Yes (X)	$0	$0	$0	Yes (X)
Michael F Long
Vice Chair (end 12/18); Secretary	2.00	1.00	Yes (X)	$0	$0	$0	Yes (X)
Brett C Peltzer
Treasurer	2.00	2.00	Yes (X)	$0	$0	$0	Yes (X)
Brenan Riehl
Secretary (end 12/18); Trustee	2.00	0.00	Yes (X)	$0	$0	$0	Yes (X)
Susan E Mooney MD MS
President & CEO	53.00	8.00	Yes (X)	$394,846	$34,334	$62,227	Yes (X)
Randall D Lea MD MPH
VP/Chief Medical Officer (end 8/18)	28.00	1.00	Yes (X)	$152,531	$0	$23,684	Yes (X)
Brenda L Blair
VP & COO	32.00	29.00	Yes (X)	$208,308	$0	$28,091	Yes (X)
Christopher Fallon
Interim CFO	40.00	20.00		$0	$0	$0	Yes (X)
Timothy Graham MBA FHFMA CPA
Interim CFO (end 1/19)	40.00	20.00		$230,762	$57,690	$0	Yes (X)
Kathryn M Vargo MD
Medical Staff President	30.00	1.00		$172,697	$0	$40,489	Yes (X)
Ivan Tomek MD
Orthopaedic Surgeon	40.00	0.00		$540,741	$0	$58,401		Yes (X)
Dale C Vidal MD MS
Exec. Dir., Multi-Specialty Clinic	40.00	0.00		$517,597	$0	$46,835		Yes (X)
Leonard M Rudolf MD
Orthopaedic Surgeon	40.00	0.00		$476,641	$0	$29,493		Yes (X)
Paul Sansone MD
Anesthesiologist	40.00	0.00		$432,208	$0	$40,672		Yes (X)
Diane C Riley MD
Orthopaedic Surgeon	40.00	0.00		$440,704	$0	$34,624		Yes (X)

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$4,083,495	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$2,752,853	TotReportableCompRltdOrgAmt
Total Other Compensation	$757,785	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	42	IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed	0	FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K	Yes (1)	TotalCompGreaterThan150KInd
Compensation From Other Srcs	0	CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1Txt	CityContractorAddress/USAddress/CityNm	State AbbreviationContractorAddress/USAddress/StateAbbreviationCd	ZIPContractorAddress/USAddress/ZIPCd	ServicesServicesDesc	CompensationCompensationAmt
Upper Valley Neurology
106 Hanover Street	Lebanon	NH	03766	Neurology physician practice services	$3,484,667
EmCare Physician Services Inc
7032 Collection Center Drive	Chicago	IL	60693	Emergency room/ hospitalist services	$1,845,182
The Chappelle Group LLC
7500 Greenway Center Drive Suite 4	Greenbelt	MD	20770	Revenue cycle/ financial services	$1,134,820
American Healthcare Services Associates
PO Box 945	Traverse	MI	49685	Agency/temp employee services	$743,718
Conifer Revenue Cycle Solutions LLC
PO Box 655025	Dallas	TX	75265	Coding operations	$595,114

Field	Value	IRS element (for citing)
Cntrct Rcvd Greater Than100 K	14	CntrctRcvdGreaterThan100KCnt
Federated Campaigns	$10,000	FederatedCampaignsAmt
Related Organizations	$33,000	RelatedOrganizationsAmt
Government Grants	$51,825	GovernmentGrantsAmt
All Other Contributions	$587,302	AllOtherContributionsAmt
Noncash Contributions	$2,145	NoncashContributionsAmt
Total Contributions	$682,127	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (4 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
Patient services	621400	$65,989,656	$65,989,656
NH DSH payments	962140	$5,699,996	$5,699,996
Other operating services	621400	$1,431,314	$1,431,314
Nutritional services	722210	$103,699	$103,699

Field	Value	IRS element (for citing)
Total Program Service Revenue	$73,224,665	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$600,027	TotalRevenueColumnAmt
Unrelated Business Revenue	$26	UnrelatedBusinessRevenueAmt
Exclusion	$600,001	ExclusionAmt

Gross Rents GrossRentsGrp

Field	Value	IRS element (for citing)
Real	$73,806	RealAmt

Less Rental Expenses LessRentalExpensesGrp

Field	Value	IRS element (for citing)
Real	$0	RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Real	$73,806	RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$73,806	TotalRevenueColumnAmt
Exclusion	$73,806	ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

Field	Value	IRS element (for citing)
Securities	$415,690	SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

Field	Value	IRS element (for citing)
Securities	$0	SecuritiesAmt

Gain Or Loss GainOrLossGrp

Field	Value	IRS element (for citing)
Securities	$415,690	SecuritiesAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$415,690	TotalRevenueColumnAmt
Exclusion	$415,690	ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp

Field	Value	IRS element (for citing)
Desc	Loss on extinguishment of debt	Desc
Business	621400	BusinessCd
Total Revenue Column	-$87,304	TotalRevenueColumnAmt
Exclusion	-$87,304	ExclusionAmt

Field	Value	IRS element (for citing)
Other Revenue Total	-$87,304	OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$74,909,011	TotalRevenueColumnAmt
Related Or Exempt Func Income	$73,224,665	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$26	UnrelatedBusinessRevenueAmt
Exclusion	$1,002,193	ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

Field	Value	IRS element (for citing)
Total	$195,358	TotalAmt
Program Services	$195,358	ProgramServicesAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

Field	Value	IRS element (for citing)
Total	$25,207	TotalAmt
Program Services	$25,207	ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

Field	Value	IRS element (for citing)
Total	$1,308,658	TotalAmt
Program Services	$694,087	ProgramServicesAmt
Management And General	$610,645	ManagementAndGeneralAmt
Fundraising	$3,926	FundraisingAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$36,138,047	TotalAmt
Program Services	$34,836,235	ProgramServicesAmt
Management And General	$1,193,398	ManagementAndGeneralAmt
Fundraising	$108,414	FundraisingAmt

Pension Plan Contributions PensionPlanContributionsGrp

Field	Value	IRS element (for citing)
Total	$527,571	TotalAmt
Program Services	$519,520	ProgramServicesAmt
Management And General	$6,468	ManagementAndGeneralAmt
Fundraising	$1,583	FundraisingAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$3,682,666	TotalAmt
Program Services	$3,524,254	ProgramServicesAmt
Management And General	$147,364	ManagementAndGeneralAmt
Fundraising	$11,048	FundraisingAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$2,093,788	TotalAmt
Program Services	$1,989,099	ProgramServicesAmt
Management And General	$98,408	ManagementAndGeneralAmt
Fundraising	$6,281	FundraisingAmt

Fees For Services Legal FeesForServicesLegalGrp

Field	Value	IRS element (for citing)
Total	$23,333	TotalAmt
Management And General	$23,333	ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$123,323	TotalAmt
Management And General	$123,323	ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$7,004,639	TotalAmt
Program Services	$6,654,407	ProgramServicesAmt
Management And General	$329,218	ManagementAndGeneralAmt
Fundraising	$21,014	FundraisingAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$53,734	TotalAmt
Management And General	$53,734	ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$1,407,603	TotalAmt
Program Services	$261,355	ProgramServicesAmt
Management And General	$1,141,950	ManagementAndGeneralAmt
Fundraising	$4,298	FundraisingAmt

Information Technology InformationTechnologyGrp

Field	Value	IRS element (for citing)
Total	$211,151	TotalAmt
Program Services	$200,594	ProgramServicesAmt
Management And General	$9,924	ManagementAndGeneralAmt
Fundraising	$633	FundraisingAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$2,918,746	TotalAmt
Program Services	$2,772,809	ProgramServicesAmt
Management And General	$137,181	ManagementAndGeneralAmt
Fundraising	$8,756	FundraisingAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$176,270	TotalAmt
Program Services	$167,456	ProgramServicesAmt
Management And General	$8,285	ManagementAndGeneralAmt
Fundraising	$529	FundraisingAmt

Conferences Meetings ConferencesMeetingsGrp

Field	Value	IRS element (for citing)
Total	$59,371	TotalAmt
Program Services	$56,403	ProgramServicesAmt
Management And General	$2,790	ManagementAndGeneralAmt
Fundraising	$178	FundraisingAmt

Interest InterestGrp

Field	Value	IRS element (for citing)
Total	$1,169,218	TotalAmt
Program Services	$1,110,757	ProgramServicesAmt
Management And General	$54,953	ManagementAndGeneralAmt
Fundraising	$3,508	FundraisingAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$2,304,856	TotalAmt
Program Services	$2,189,613	ProgramServicesAmt
Management And General	$108,328	ManagementAndGeneralAmt
Fundraising	$6,915	FundraisingAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$636,370	TotalAmt
Program Services	$604,552	ProgramServicesAmt
Management And General	$29,909	ManagementAndGeneralAmt
Fundraising	$1,909	FundraisingAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt	Management And GeneralManagementAndGeneralAmt	FundraisingFundraisingAmt
Drugs/medical supplies	$8,634,076	$8,202,372	$405,802	$25,902
New Hampshire MET	$3,061,947	$3,061,947
Repairs/maintenance	$2,297,210	$2,182,349	$107,969	$6,892
Provision for bad debts	$1,756,016	$1,756,016

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	$176,028	TotalAmt
Program Services	$167,227	ProgramServicesAmt
Management And General	$8,273	ManagementAndGeneralAmt
Fundraising	$528	FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$75,985,186	TotalAmt
Program Services	$71,171,617	ProgramServicesAmt
Management And General	$4,601,255	ManagementAndGeneralAmt
Fundraising	$212,314	FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

Field	Value	IRS element (for citing)
BOY	$1,247,096	BOYAmt
EOY	$2,159	EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

Field	Value	IRS element (for citing)
BOY	$4,698,217	BOYAmt
EOY	$7,063,489	EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$158,696	BOYAmt
EOY	$120,009	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$7,996,791	BOYAmt
EOY	$7,282,615	EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

Field	Value	IRS element (for citing)
BOY	$1,322,780	BOYAmt
EOY	$735,346	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$892,831	BOYAmt
EOY	$205,316	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$64,765,385	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$33,841,742	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$25,585,296	BOYAmt
EOY	$30,923,643	EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

Field	Value	IRS element (for citing)
BOY	$15,841,735	BOYAmt
EOY	$17,948,875	EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

Field	Value	IRS element (for citing)
BOY	$8,500	BOYAmt
EOY	$9,805,137	EOYAmt

Intangible Assets IntangibleAssetsGrp

Field	Value	IRS element (for citing)
BOY	$139,333	BOYAmt

Other Assets Total OtherAssetsTotalGrp

Field	Value	IRS element (for citing)
BOY	$2,288,857	BOYAmt
EOY	$2,311,863	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$60,180,132	BOYAmt
EOY	$76,398,452	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$8,894,447	BOYAmt
EOY	$8,405,326	EOYAmt

Deferred Revenue DeferredRevenueGrp

Field	Value	IRS element (for citing)
BOY	$99,676	BOYAmt
EOY	$33,082	EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$15,408,101	BOYAmt
EOY	$25,740,604	EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

Field	Value	IRS element (for citing)
BOY	$399,825	BOYAmt
EOY	$248,731	EOYAmt

Other Liabilities OtherLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$13,712,586	BOYAmt
EOY	$13,521,902	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$38,514,635	BOYAmt
EOY	$47,949,645	EOYAmt

Field	Value	IRS element (for citing)
Organization Follows SFAS117	Yes (X)	OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$21,030,940	BOYAmt
EOY	$27,652,645	EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$415,262	BOYAmt
EOY	$699,162	EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$219,295	BOYAmt
EOY	$97,000	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$21,665,497	BOYAmt
EOY	$28,448,807	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$60,180,132	BOYAmt
EOY	$76,398,452	EOYAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	Yes (X)	InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss	-$1,076,175	ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst	-$517,974	NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets	$8,377,459	OtherChangesInNetAssetsAmt
Info In Schedule O Part XII	Yes (X)	InfoInScheduleOPartXIIInd
Method Of Accounting Accrual	Yes (X)	MethodOfAccountingAccrualInd
Accountant Compile Or Review	0	AccountantCompileOrReviewInd
FS Audited	Yes (1)	FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

Field	Value	IRS element (for citing)
Consolidated Basis Fincl Stmt	Yes (X)	ConsolidatedBasisFinclStmtInd

Field	Value	IRS element (for citing)
Audit Committee	Yes (1)	AuditCommitteeInd
Federal Grant Audit Required	Yes (1)	FederalGrantAuditRequiredInd
Federal Grant Audit Performed	Yes (1)	FederalGrantAuditPerformedInd

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital	Yes (X)	HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

Field	Value	IRS element (for citing)
Contributor	RESTRICTED	ContributorNum

Contributor Business Name ContributorBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	RESTRICTED	BusinessNameLine1

Contributor US Address ContributorUSAddress

Field	Value	IRS element (for citing)
Address Line1	RESTRICTED	AddressLine1
Address Line2	RESTRICTED	AddressLine2
City	RESTRICTED	City
State	RESTRICTED	State
ZIP Code	RESTRICTED	ZIPCode

Field	Value	IRS element (for citing)
Total Contributions	RESTRICTED	TotalContributionsAmt

Schedule C IRS990ScheduleC

Field	Value	IRS element (for citing)
Volunteers	0	VolunteersInd
Paid Staff Or Management	0	PaidStaffOrManagementInd
Media Advertisements	0	MediaAdvertisementsInd
Mailings Members	0	MailingsMembersInd
Publications Or Broadcast	0	PublicationsOrBroadcastInd
Grants Other Organizations	Yes (1)	GrantsOtherOrganizationsInd
Grants Other Organizations	$10,834	GrantsOtherOrganizationsAmt
Direct Contact Legislators	0	DirectContactLegislatorsInd
Rallies Demonstrations	0	RalliesDemonstrationsInd
Other Activities	Yes (1)	OtherActivitiesInd
Other Activities	$3,750	OtherActivitiesAmt
Total Lobbying Expenditures	$14,584	TotalLobbyingExpendituresAmt
Not Described Section501c3	0	NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	Part II-B, Line 1:	FormAndLineReferenceDesc
Explanation	Alice Peck Day Memorial Hospital was a member of the American Hospital Association and the New Hampshire Hospital Association in the fiscal year ended June 30, 2019. A portion of the dues paid to these organizations were available for lobbying expenditures on behalf of Alice Peck Day Memorial Hospital and the other member organizations in furtherance of their exempt purposes. The total dues paid by the Hospital to these organizations, and the portion that was available for lobbying, are detailed below: American Hospital Association - total dues: $40,577 American Hospital Association - amount available for lobbying: $7,588 New Hampshire Hospital Association - total dues: $14,280 New Hampshire Hospital Association - amount available for lobbying: $3,246 Also, the Hospital belongs to the 10 Mile CAH Coalition which engaged Strategic Health Resources (SHR) for purposes of furthering lobbying efforts with regards to attempts to eliminate CAH status. The CEO participates in periodic telephone calls with this group in attempts to keep the issue of rural healthcare and the key role that CAHs play in rural healthcare in front of the various legislative delegations.	ExplanationTxt

Schedule D IRS990ScheduleD

CY Endwmt Fund CYEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$218,390	BeginningYearBalanceAmt
Other Expenditures	$33,217	OtherExpendituresAmt
End Year Balance	$185,173	EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$33,230	BeginningYearBalanceAmt
Investment Earnings Or Losses	$185,160	InvestmentEarningsOrLossesAmt
End Year Balance	$218,390	EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$31,845	BeginningYearBalanceAmt
Investment Earnings Or Losses	$1,385	InvestmentEarningsOrLossesAmt
End Year Balance	$33,230	EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$30,268	BeginningYearBalanceAmt
Investment Earnings Or Losses	$1,577	InvestmentEarningsOrLossesAmt
End Year Balance	$31,845	EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$30,883	BeginningYearBalanceAmt
Investment Earnings Or Losses	-$615	InvestmentEarningsOrLossesAmt
End Year Balance	$30,268	EndYearBalanceAmt

Field	Value	IRS element (for citing)
Board Designated Balance EOY	0.47620	BoardDesignatedBalanceEOYPct
Prmnnt Endowment Balance EOY	0.52380	PrmnntEndowmentBalanceEOYPct
Term Endowment Balance EOY	0.00000	TermEndowmentBalanceEOYPct
Endowments Held Unrelated Org	0	EndowmentsHeldUnrelatedOrgInd
Endowments Held Related Org	0	EndowmentsHeldRelatedOrgInd

Land LandGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$927,577	OtherCostOrOtherBasisAmt
Book Value	$927,577	BookValueAmt

Buildings BuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$33,997,949	OtherCostOrOtherBasisAmt
Depreciation	$13,440,278	DepreciationAmt
Book Value	$20,557,671	BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$212,775	OtherCostOrOtherBasisAmt
Depreciation	$212,775	DepreciationAmt
Book Value	$0	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$28,894,020	OtherCostOrOtherBasisAmt
Depreciation	$20,188,689	DepreciationAmt
Book Value	$8,705,331	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$733,064	OtherCostOrOtherBasisAmt
Book Value	$733,064	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$30,923,643	TotalBookValueLandBuildingsAmt

Other Securities OtherSecuritiesGrp

Field	Value	IRS element (for citing)
Desc	Investment in affiliate	Desc
Book Value	$9,805,137	BookValueAmt
Method Valuation	F	MethodValuationCd

Field	Value	IRS element (for citing)
Total Book Value Securities	$9,805,137	TotalBookValueSecuritiesAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)

DescDesc	AmtAmt
Medical liabilities and payables	$513,000
Estimated third-party payor settlements	$1,290,446
Accrued construction costs for building under development	$10,568,277
Due to affiliates	$1,150,179

Field	Value	IRS element (for citing)
Total Liability	$13,521,902	TotalLiabilityAmt
Footnote Text	Yes (X)	FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDesc

ExplanationExplanationTxt

Part V, Line 4:

The Organization uses the income from its endowment funds for use in operations.

Part X, Line 2:

Dartmouth-Hitchcock Health (D-HH) serves as the sole corporate member of the following entities: Dartmouth-Hitchcock Clinic and Subsidiaries (DHC), Mary Hitchcock Memorial Hospital and Subsidiaries (MHMH), (DHC and MHMH together are referred to as D-H), The New London Hospital Association and Subsidiaries (NLH), Windsor Hospital Corporation (d/b/a Mt. Ascutney Hospital and Health Center) and Subsidiaries (MAHHC), Cheshire Medical Center and Subsidiaries (Cheshire), Alice Peck Day Memorial Hospital and, effective July 1, 2018, Subsidiary (APD), and the Visiting Nurse and Hospice for Vermont and New Hampshire and Subsidiaries (VNH). The "Health System" consists of D-HH, its members and their subsidiaries. The Health System currently operates one tertiary, one community and three acute care (critical access) hospitals in New Hampshire (NH) and Vermont (VT). One facility provides inpatient and outpatient rehabilitation medicine and long-term care. The Health System also operates multiple physician practices, a nursing home, a continuing care retirement community, and a home health and hospice service. The Health System operates a graduate level program for health professions and is the principal teaching affiliate of the Geisel School of Medicine (Geisel), a component of Dartmouth College. D-HH, Dartmouth-Hitchcock Clinic, Mary Hitchcock Memorial Hospital, The New London Hospital Association, Cheshire Medical Center, and Alice Peck Day Memorial Hospital are NH not-for-profit corporations exempt from federal income taxes under Section 501(c)(3) of the Internal Revenue Code (IRC). Windsor Hospital Corporation and the Visiting Nurse and Hospice of VT and NH are VT not-for-profit corporations exempt from federal income taxes under Section 501(c)(3) of the IRC.

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Financial Assistance Policy	Yes (1)	FinancialAssistancePolicyInd
Written Policy	Yes (1)	WrittenPolicyInd
FPG Reference Free Care	Yes (1)	FPGReferenceFreeCareInd
Percent100	Yes (X)	Percent100Ind
FPG Reference Discounted Care	Yes (1)	FPGReferenceDiscountedCareInd
Percent300	Yes (X)	Percent300Ind
Free Care Medically Indigent	Yes (1)	FreeCareMedicallyIndigentInd
Financial Assistance Budget	Yes (1)	FinancialAssistanceBudgetInd
Expenses Exceed Budget	0	ExpensesExceedBudgetInd
Annual Community Bnft Report	Yes (1)	AnnualCommunityBnftReportInd
Report Publically Available	Yes (1)	ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$300,967	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$300,967	NetCommunityBenefitExpnsAmt
Total Expense	0.00410	TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$6,001,013	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$7,963,826	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$6,301,980	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$7,963,826	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$300,967	NetCommunityBenefitExpnsAmt
Total Expense	0.00410	TotalExpensePct

Community Health Services CommunityHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$221,683	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$221,683	NetCommunityBenefitExpnsAmt
Total Expense	0.00300	TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$8,000	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$8,000	NetCommunityBenefitExpnsAmt
Total Expense	0.00010	TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$19,653,971	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$14,692,835	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$4,961,136	NetCommunityBenefitExpnsAmt
Total Expense	0.06680	TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$44,492	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$44,492	NetCommunityBenefitExpnsAmt
Total Expense	0.00060	TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$19,928,146	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$14,692,835	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$5,235,311	NetCommunityBenefitExpnsAmt
Total Expense	0.07050	TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$26,230,126	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$22,656,661	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$5,536,278	NetCommunityBenefitExpnsAmt
Total Expense	0.07460	TotalExpensePct

Community Support CommunitySupportGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$16,117	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$16,117	NetCommunityBenefitExpnsAmt
Total Expense	0.00020	TotalExpensePct

Health Improvement Advocacy HealthImprovementAdvocacyGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$17,009	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$17,009	NetCommunityBenefitExpnsAmt
Total Expense	0.00020	TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$33,126	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$33,126	NetCommunityBenefitExpnsAmt
Total Expense	0.00040	TotalExpensePct

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	Yes (1)	BadDebtExpenseReportedInd
Bad Debt Expense	$1,158,530	BadDebtExpenseAmt
Bad Debt Expense Attributable	$0	BadDebtExpenseAttributableAmt
Reimbursed By Medicare	$16,908,993	ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr	$17,177,309	CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall	-$268,316	MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

Field	Value	IRS element (for citing)
Cost To Charge Ratio	Yes (X)	CostToChargeRatioInd

Field	Value	IRS element (for citing)
Written Debt Collection Policy	Yes (1)	WrittenDebtCollectionPolicyInd
Financial Assistance Prvsn	Yes (1)	FinancialAssistancePrvsnInd
Hospital Facilities	1	HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

Field	Value	IRS element (for citing)
Facility	1	FacilityNum

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	Alice Peck Day Memorial Hospital	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	10 Alice Peck Day Drive	AddressLine1Txt
City	Lebanon	CityNm
State Abbreviation	NH	StateAbbreviationCd
ZIP	03766	ZIPCd

Field	Value	IRS element (for citing)
Website Address	www.alicepeckday.org	WebsiteAddressTxt
State License	00016	StateLicenseNum
Licensed Hospital	Yes (X)	LicensedHospitalInd
General Medical And Surgical	Yes (X)	GeneralMedicalAndSurgicalInd
Critical Access Hospital	Yes (X)	CriticalAccessHospitalInd
Emergency Room24 Hrs	Yes (X)	EmergencyRoom24HrsInd
Other	Physician Clinics	OtherDesc

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

Field	Value	IRS element (for citing)
Business Name Line1	Alice Peck Day Memorial Hospital	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Facility	1	FacilityNum
First Licensed CY Or PY	0	FirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PY	0	TaxExemptHospitalCYOrPYInd
CHNA Conducted	Yes (1)	CHNAConductedInd
Community Definition	Yes (X)	CommunityDefinitionInd
Community Demographics	Yes (X)	CommunityDemographicsInd
Existing Resources	Yes (X)	ExistingResourcesInd
How Data Obtained	Yes (X)	HowDataObtainedInd
Community Health Needs	Yes (X)	CommunityHealthNeedsInd
Other Health Issues	Yes (X)	OtherHealthIssuesInd
Community Hlth Needs Id Process	Yes (X)	CommunityHlthNeedsIdProcessInd
Consulting Process	Yes (X)	ConsultingProcessInd
CHNA Conducted	18	CHNAConductedYr
Take Into Account Others Input	Yes (1)	TakeIntoAccountOthersInputInd
CHNA Conducted With Other Fclts	Yes (1)	CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non Fclts	Yes (1)	CHNAConductedWithNonFcltsInd
CHNA Report Widely Available	Yes (1)	CHNAReportWidelyAvailableInd
Rpt Available On Own Website	Yes (X)	RptAvailableOnOwnWebsiteInd
Own Website URL	See Part V, Section C	OwnWebsiteURLTxt
Other Website	Yes (X)	OtherWebsiteInd
Other Website URL	See Part V, Section C	OtherWebsiteURLTxt
Paper Copy Public Inspection	Yes (X)	PaperCopyPublicInspectionInd
Implementation Strategy Adopt	Yes (1)	ImplementationStrategyAdoptInd
Implementation Strategy Adpt	16	ImplementationStrategyAdptYr
Strategy Posted Website	Yes (1)	StrategyPostedWebsiteInd
Strategy Website URL	See Part V, Section C	StrategyWebsiteURLTxt
Strategy Attached	Yes (1)	StrategyAttachedInd
Organization Incur Excise Tax	0	OrganizationIncurExciseTaxInd
Elig Criteria Explained	Yes (1)	EligCriteriaExplainedInd
FPG Family Incm Lmt Free Dscnt	Yes (X)	FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care	100.000000000000	FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care	300.000000000000	FPGFamilyIncmLmtDscntCarePct
Asset Level Criteria	Yes (X)	AssetLevelCriteriaInd
Medical Indigency Criteria	Yes (X)	MedicalIndigencyCriteriaInd
Insurance Status Criteria	Yes (X)	InsuranceStatusCriteriaInd
Underinsurance Stat Criteria	Yes (X)	UnderinsuranceStatCriteriaInd
Residency Criteria	Yes (X)	ResidencyCriteriaInd
Other Criteria	Yes (X)	OtherCriteriaInd
Explained Basis	Yes (1)	ExplainedBasisInd
App Financial Asst Expln	Yes (1)	AppFinancialAsstExplnInd
Described Info	Yes (X)	DescribedInfoInd
Described Suprt Doc	Yes (X)	DescribedSuprtDocInd
Provided Hospital Contact	Yes (X)	ProvidedHospitalContactInd
Provided Nonprofit Contact	Yes (X)	ProvidedNonprofitContactInd
Includes Publicity Measures	Yes (1)	IncludesPublicityMeasuresInd
FAP Available On Website	Yes (X)	FAPAvailableOnWebsiteInd
FAP Available On Website URL	See Part V, Section C	FAPAvailableOnWebsiteURLTxt
FAP App Available On Website	Yes (X)	FAPAppAvailableOnWebsiteInd
FAP App Available On Website URL	see Part V, Section C	FAPAppAvailableOnWebsiteURLTxt
FAP Summary On Website	Yes (X)	FAPSummaryOnWebsiteInd
FAP Summary On Website URL	see Part V, Section C	FAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No Charge	Yes (X)	FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No Chrg	Yes (X)	FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No Chrg	Yes (X)	FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill Display	Yes (X)	NotifiedFAPCopyBillDisplayInd
Communtity Notified FAP	Yes (X)	CommuntityNotifiedFAPInd
FAP Translated	Yes (X)	FAPTranslatedInd
Other Publicity	Yes (X)	OtherPublicityInd
FAP Actions On Nonpayment	Yes (1)	FAPActionsOnNonpaymentInd
Permit No Actions	Yes (X)	PermitNoActionsInd
Collection Activities	0	CollectionActivitiesInd
Provided Written Notice	Yes (X)	ProvidedWrittenNoticeInd
Made Effort Orally Notify	Yes (X)	MadeEffortOrallyNotifyInd
Processed FAP Application	Yes (X)	ProcessedFAPApplicationInd
Made Presumptive Elig Determ	Yes (X)	MadePresumptiveEligDetermInd
Nondis Emergency Care Policy	Yes (1)	NondisEmergencyCarePolicyInd
Look Back Medicaid Medcr Prvt	Yes (X)	LookBackMedicaidMedcrPrvtInd
Amounts Generally Billed	0	AmountsGenerallyBilledInd
Gross Charges	0	GrossChargesInd

Supplemental Information SupplementalInformationGrp (8 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Alice Peck Day Memorial Hospital	Part V, Section B, Line 5: With a shared Hospital Service Area, Alice Peck Day Memorial Hospital collaborated with Dartmouth-Hitchcock in conducting the fiscal year 2019 Community Health Needs Assessment. Technical expertise was provided by the New Hampshire Community Health Institute, the NH affiliate of JSI, a nation-wide public health management consulting and research organization. Methods employed in the assessment included surveys of community residents made available online and paper surveys placed in numerous locations throughout the region (completed by 2,100 individuals), a direct email survey of key stakeholders and community leaders representing multiple community sectors; a set of community discussion groups; compilation of results from assessment activities focused specifically on behavioral health needs and gaps; and a review of available population demographics and health status indicators. All information collection activities and analyses sought to focus assessment activities on vulnerable and disproportionately served populations in the region including populations that could experience limited access to health-related services or resources due to income, age, disability, and social or physical isolation. Enhanced efforts were made to understand the needs of these populations through targeted surveys and community conversations including facilitated surveys and discussions at community suppers, a regional free clinic, homeless programs, and other community settings serving economically vulnerable residents. The data gathered in the FY2019 CHNA is part of a continual process for considering progress and emerging community needs informed by dialogue with community members, leaders, and experience.
Alice Peck Day Memorial Hospital	Part V, Section B, Line 6a: Alice Peck Day Memorial HospitalDartmouth-Hitchcock Medical CenterNew London Hospital Valley Regional Hospital Mt. Ascutney Hospital and Health CenterVisiting Nurse and Hospice for VT and NH
Alice Peck Day Memorial Hospital	Part V, Section B, Line 6b: Technical assistance for the Hospital's 2018 CHNA was provided by the New Hampshire Community Health Institute.
Alice Peck Day Memorial Hospital	Part V, Section B, Line 11: Please see attached Implementation Plan. The most recent CHNA was made widely available to the public in tax year 2018. The Implementation Plan that was approved by the board for that CHNA was done in November of 2019, which is within the deadline as prescribed by 501(r). Due to IRS filing instructions, since this approval date is after the tax year covered by this return, the previous Implenetation Plan date has been indicated in Schedule H, Part V, Line 9. Both Implementation Plans have been attached to this return.
Alice Peck Day Memorial Hospital	Part V, Section B, Line 13h: Alice Peck Day Memorial Hospital offers financial assistance to patients demonstrating need. In making the need determination, APD participates with and honors the founding principles and guidelines of the New Hampshire Health Access Network (NHHAN). Accordingly, decisions regarding the granting of financial assistance will be based primarily on a patient and their household income and assets. There will be minimal consideration of expenses except when they identify areas for further investigation or incomplete or inaccurate information. The value of a patient's principal residence is not considered in qualifying a patient for in-house assistance. APD requires exhaustion of other payment methodologies, including but not limited to, worker's compensation, veterans benefits, Medicaid, liability insurance, victims of crime, and COBRA. When applicable, proof of determination may be required prior to consideration for financial assistance.
Alice Peck Day Memorial Hospital	Part V, Section B, Line 16j: Please see Part V, Line 3 for a description of the financial assistance program and the efforts made to publicize and promote the program.Alice Peck Day Memorial Hospital prints and distributes its financial assistance application in Spanish when requested.
Part V, Line 7a & 7b:	CHNA can be found on the Hospital's website at:https://www.alicepeckday.org/assets/FY2019_DHAPDVNA_Community_Health_Needs_Assessment.pdf Other websites: https://www.dartmouth-hitchcock.org/documents/fy2019_dhapdvna_community_health_needs_assessment.pdf
Part V, Line 10a:	Implementation Plan in effect during the tax year covered by this return can be found at: https://www.alicepeckday.org/assets/APDMH_CH_Implementation_Plan_2017.pdfThe Hospital's Implementation Plan for its most recent CHNA (see narrative for Schedule H, Part V, Line 9 can be found at:https://www.alicepeckday.org/assets/ADOPTED_APD_Community_Health_Implementation_Plan_November-1-2019.pdf

Field	Value	IRS element (for citing)
Facility	7	FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (7 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	FacilityFacilityTxt
1 - Neurosurgery Services at APD (NSAPD)
106 Hanover Street	Lebanon	NH	03766	Neurosurgery Physician Clinic
2 - RAM Center for Community Care
10 Alice Peck Day Drive	Lebanon	NH	03766	Primary Care Physician Clinic
3 - APD Orthopaedic Clinic
10 Alice Peck Day Drive	Lebanon	NH	03766	Orthopaedic Physician Clinic
4 - Women's Care Center
10 Alice Peck Day Drive	Lebanon	NH	03766	OB/GYN Physician Clinic
5 - General Surgery Clinic
10 Alice Peck Day Drive	Lebanon	NH	03766	General Surgeon Clinic
6 - Pain Management Clinic
10 Alice Peck Day Drive	Lebanon	NH	03766	Pain Management Clinic
7 - Occuptational Health Services
10 Alice Peck Day Drive	Lebanon	NH	03766	Occupational Health Physician Clinic

Supplemental Information Detail SupplementalInformationDetail (16 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Part I, Line 3c:	Alice Peck Day provides sliding scale coverage with 100% coverage for those with household income below 100% of the Federal Poverty Limit (FPL) and partial coverage for those with household income between 101% and 300% of FPL. The coverage tiers are maintained on the APD website, and are available from all financial counselors or by mail upon request.
Part I, Line 7:	APD has several hospital clinical services and hospital-owned physician practices. Per instructions for IRS Form 990, Schedule H, Worksheet 6, organizations may include any applicable physician practice that the Hospital subsidizes (i.e., operates at a loss) in the completing of Schedule H. Therefore, the Hospital has included the following hospital clinical services and hospital-owned physician practices that operate at a loss (i.e., are subsidized by the Hospital) and the associated costs of these practices:a. Primary care clinicb. Pain Management c. Women's Care d. General Surgerye. Orthopedicsf. Occupational HealthThe above-listed hospital clinical services and hospital-owned physician practices have a community benefit (i.e. aggregate loss or subsidy from the Hospital) of approximately $4.96 million. In addition, the community benefit does not take into account bad debts, charity care, or contractual adjustments. Thus, this community benefit of approximately $4.96 million is a conservative figure that reconciles to the community benefit information reported on IRS Form 990, Schedule H, Part I, Line 7g, Column e.
Part I, Ln 7 Col(f):	See Footnote 4 on Page 15 of the attached audited financial statements.
Part II, Community Building Activities:	Alice Peck Day actively promotes community-based leadership development. Staff members participate in the Lebanon Chamber of Commerce, Mascoma Savings Bank Board of Directors, Foundation for Healthy Communities, the Rural Health Coalition, and the Advocacy Task Force. As an active member of the community, APD works to be proactive concerning disaster readiness. Staff have participated in onsite training for disaster preparedness as well as off-site training with other regional hospitals. Collaborative efforts include all hazard regional training, emergency response training, and a regional mass casualty response program to help facilitate cooperative efforts if such needs arise.
Part III, Line 2:	Bad debt cost is calculated using a cost to charge ratio using a step-down cost allocation methodology consistent with Medicare cost reporting. In FY18, accounts written off to bad debt included gross charges being written off less any payments received against those charges. Any cash collected on accounts previously written off is included as an offset to bad debt expense as recoveries of bad debt. We estimated the amount of charity care in bad debt expense based on the number of applications for charity care. We believe the amount is minimal based on our extensive efforts to educate our patients and staff about our various payment plans and charity care to ensure that patients who qualify for any of our programs utilize them. Depending on the specific circumstances, a patient may be eligible for charity care, discounted care, time-payment programs, or a combination of the above. Due to these efforts, the amounts written off to bad debt that could qualify as charity care are minimal. The Hospital utilized Worksheet 2 from the IRS Schedule H instructions and guidance to determine the ratio of patient care to cost to charge (65.97% for fiscal year 2019), and multiplied this ratio by the Hospital's total bad debt expense of $1,756,016 to determine the Part II, Line 2 bad debt expense of $1,158,530.Management performs collection rate look-back analyses on a quarterly basis to evaluate the sufficiency of the allowance for estimated uncollectibles. Throughout the year, after all reasonable collection efforts have been exhausted, the difference between the standard rates and the amounts actually collected, including contractual adjustments and uninsured discounts, will be written off against the allowance for estimated uncollectibles. In addition to the review of the categories of revenue, management monitors the write offs against established allowances as of a point in time to determine the appropriateness of the underlying assumptions used in estimating the allowance for estimated uncollectibles.
Part III, Line 3:	See narrative for Schedule H, Part III, Line 2 and Line 4.
Part III, Line 4:	See Footnote 4 on Page 15 of the attached audited financial statements.
Part III, Line 8:	Form 990, Schedule H instructions and guidance contain a template (Worksheet 2) that may be used to determine the overall cost to charge ratio that could be applied throughout Schedule H in order to convert charges to cost. Where applicable, the Hospital has utilized Worksheet 2 for various calculations. The only areas where Worksheet 2 was not utilized for Part III, Line 8 was Schedule H, Worksheet B, Line 2 & 6, Medicare Allowable Costs and Payments Related to Subsidized Health Services. The Hospital utilized the Medicare cost report for estimated cost and payment for these services. The Hospital believes that its hospital clinical services, hospital-owned physician practices, emergency room and inpatient psychiatric units listed above should all be considered community benefits. These services, facilities, and programs provide a benefit to community members, and are both offered and subsidized by the Hospital. Medicare shortfall is reported to the State of New Hampshire in the Community Benefits Report, under Section 4, Unreimbursed Costs, Government-Sponsored Health Care.In prior years, the State of New Hampshire used MET dollars to service the general fund of the State. However, recently the State has used these dollars to directly fund medical and other related budgetary goals. As a result of this change in the State's appropriation of these funds, the net MET/DSH impact is considered a healthcare-related expenditure by the Hospital.
Part III, Line 9b:	Our bad debts collection policy applies to all patient accounts in a consistent manner. The policy specifically indicates that, after a second statement is sent with no payment received, a patient accounts representative will contact the patient by phone to determine if a financial assistance application or payment plan is appropriate. This is completed to avoid further escalation of past due account(s) if the patient may qualify for full or partial relief under the charity care policy. If the application is successful, then the qualifying balance or balances are classified as charity care and no longer pursued for collections. Once a patient balance is classified as charity care, it is not subject to collection activities. Alice Peck Day is committed to helping our patients obtain quality healthcare, regardless of ability to pay. Our financial assistance programs encourage and enable our patients to make healthcare decisions free of financial barriers. We educate our patients about our programs and provide assistance prior to their receiving services, at registration for services, and during our billing process to ensure that any and all patients in need of assistance are provided with the help they qualify for under APD programs. Brochures and signs are placed in high traffic areas such as the ER and registration. Our staff is trained to identify patients during registration, provide information, and offer assistance in completing the necessary forms. During our billing process, calls are made to patients with outstanding balances. APD staff work with patients to identify problems they are facing in dealing with outstanding balances. Patients are notified again of the many types of financial assistance available for which they may qualify. Programs are explained and assistance is offered, if needed, in completing the applications. Due to this multi-level approach and staff that is trained to identify clients who may need financial assistance, very few qualifying patients reach the point of bad debt. Our collection policies and procedures, in conjunction with our small size, allow our organization to place great emphasis on helping all patients who may be in need to apply for, and obtain, the appropriate level of financial assistance.
Schedule H, Part V, Section B, Line 16a-16c:	Financial Assistance Policy, Financial Assistance Policy Application, and Plain Languange Summary can be found at: https://www.alicepeckday.org/patients/financial_services
Part VI, Line 2:	In addition to completing a comprehensive needs assessment every three years, the Organization's Community Health Director serves on the Steering Committee of the Public Health Council of the Upper Valley, one of the State of New Hampshire's 13 regional health networks, which also serves 22 communities in Vermont. The PHC is comprised of community leaders and representatives from multiple community sectors, working together to set regional health priorities, provide guidance to regional public health activities, and ensure coordination of health improvement projects. In 2014, the PHC created the Upper Valley Agenda for Public Health, and the following year, the 2015-2017 Upper Valley Community Health Improvement Plan. This plan will be updated in the summer of 2019 with input from APD's Community Health Director. The Public Health Council provides a "finger on the pulse" of the community, and by serving in a leadership role, Alice Peck Day Memorial Hospital is able to stay abreast of the health care needs of our local service area.
Part VI, Line 3:	Alice Peck Day believes that quality health care should be available to all, regardless of ability to pay. Our financial assistance programs and staff are dedicated to helping people obtain the care they need. We reach out to our patients in many different ways to ensure that they are aware that help is available and to help guide them through the process. Brochures and signage are posted in high traffic areas such as the emergency room, registration, and the lobby. Registration staff are trained to identify patients who may be in need of financial assistance. Once identified, staff notify the patient that APD has various forms of financial assistance and explain that assistance is available for anyone who might require help or guidance in completing any necessary paperwork. In addition to the above, our billing staff are trained to help identify and offer assistance to anyone who might require financial assistance. Patients with outstanding claims are contacted by our credit coordinator who works with them to clear up balances through the variety of programs we offer. Assistance is also provided in applying for federal/state programs to those who qualify. Specially trained staff guide applicants through the process to ensure forms are filled out correctly, all required documentation is attached, and the applicants understand what they can expect to happen along the way.
Part VI, Line 4:	Alice Peck Day Memorial Hospital is part of the Lebanon Health Care service area. The Lebanon service area comprises cities and towns in New Hampshire and Vermont. APD's service area in NH comprises 15 towns in addition to the city of Lebanon, including Canaan, Cornish, Croydon, Dorchester, Enfield, Grafton, Grantham, Hanover, Lyme, Newport, Orange, Orford, Piermont, Plainfield, and Warren. Vermont towns include East Thetford, Fairlee, Hartford, Hartland, North Hartland, North Thetford, Norwich, Post Mills, Quechee, Sharon, South Strafford, Strafford, Thetford, Thetford Center, Vershire, West Vershire, West Fairlee, West Hartford, White River Junction and Woodstock.Demographics: Age: According to the 2016 American Community Survey, the population of the APD Service Area is slightly older on average than the New Hampshire and Vermont populations. 17.5% of the service area is over age 65, compared with 15.8% in New Hampshire and 17% in Vermont.Income and poverty: 11.5% of children in the hospital service area live at or below 100% FPL, with 25.7% living below 200% FPL. Education: A higher proportion of the hospital service area (94.4%) have earned at least a high school diploma or equivalent compared to New Hampshire (92.6%) and Vermont (91.9%) overall.Language: The percent of the hospital service area, ages 5 or higher, who report speaking English "less than very well" is 0.8%, compared with a statewide rate of 1.5% in New Hampshire and 0.7% in Vermont.
Part VI, Line 5:	In addition to initiatives to deliver affordable care to our under and uninsured patients through our Financial Assistance programs, the Organization provides a wide variety of no-cost or low-cost programs and services for the community. We work in partnership with local and state agencies, including but not limited to: the Lebanon, Mascoma, Hartford, Hartland and Newport school districts; the Good Neighbor Health Clinic; Grafton County Senior Citizens Council; NH Division of Health and Human Services; NH Oral Health Coalition; Vermont Oral Health Coalition; the Public Health Council of the Upper Valley; and the Vermont Dept of Health. Among the free programs and services APD offers in response to demonstrated community need are: cash support and an in-kind donation of space for the Good Neighbor Health Clinic; vouchers for emergency prescription assistance and one-on-one assistance with applying for prescription assistance programs offered through drug companies; cash support to the Grafton County Senior Citizens Council for transportation; cash donations to human service agencies; and administrative support for "Elder Friends," a companionship program for frail, isolated elders in the community who are matched with a volunteer.APD's Community Health Department is well known in the region for Upper Valley Smiles, a unique school-based oral health program for low-income elementary school children enrolled in ten schools across the Upper Valley. The APD dental team visits each school annually, providing classroom oral health education, dental screenings, fluoride varnish, sealants and (in NH only) decay-stopping fluoride treatments and interim therapeutic restorations, all at little or no cost to parents. During FY '19, the Upper Valley Smiles program of oral health education, dental screenings, preventive treatment, and referrals to dental offices was offered in ten elementary schools. This year we also began a new program known as FitScripts. The APD FitScripts program aims to get patients exercising more and leading healthier lifestyles. FitScripts allows our primary care providers to write referrals for their patients age 16 or older, who are living with one or more chronic conditions, and for whom the cost of a gym membership has been a barrier. APD has partnered with the Carter Community Building Association (CCBA) in Lebanon, New Hampshire, and the Upper Valley Aquatic Center (UVAC) in White River Junction, Vermont, to offer this program. APD pays for the gym memberships and other associated costs. There is no cost to our patients. This year we also hosted the opening of the Mascoma River Greenway, a multi-use pathway that runs adjacent to the hospital. During the fiscal year ending June 30, 2019, cash donations were given to organizations to help those in need. Local financial contributions helped support free primary care clinics for the uninsured, provided transportation for the elderly and disabled to receive medical care, and provided local nonprofit organizations with meeting space and refreshments. Alice Peck Day also supported a free summer lunch program for low-income school-age children in Lebanon public housing sites, emergency prescription drug vouchers for uninsured patients, and "before school" morning activity program for children in the Canaan Elementary School.To promote health professional education, APD provided tuition reimbursement for students in the Surgical Tech Training Program, and hosted a Nurse Residency Program. These initiatives and ongoing efforts continue to address several of the most pressing community needs as identified in our community needs assessment.
Part VI, Line 6:	Alice Peck Day Memorial Hospital is a critical access hospital located in Lebanon, NH. We are a member of the Dartmouth-Hitchcock Health system (D-HH). D-HH is New Hampshire's only academic health system and the state's largest private employer. Its serves a population of 1.9 million across northern New England. D-HH provides access to more than 1,800 providers in almost every area of medicine, delivering care at its flagship hospital, Dartmouth-Hitchcock Medical Center (DHMC) in Lebanon, NH.The other members of D-HH include Cheshire Medical Center/Dartmouth-Hitchcock, Mt. Ascutney Hospital and Health Center, New London Hospital, and the Visiting Nurse and Hospice for Vermont and New Hampshire (VNH).
Part VI, Line 7, Reports Filed With States	NH

Schedule I IRS990ScheduleI

Field	Value	IRS element (for citing)
Grant Records Maintained	Yes (1)	GrantRecordsMaintainedInd

Recipient Table RecipientTable (3 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	Recipient EINRecipientEIN	IRC SectionIRCSectionDesc	Cash GrantCashGrantAmt	Purpose Of GrantPurposeOfGrantTxt
Grafton County Senior Citizens Council
PO Box 433	Lebanon	NH	03766	237248316	501(c)(3)	$12,000	Support for services that enable seniors to age-in-place
Good Neighbor Health Clinic
70 North Main Street	White River Junction	VT	05001	030346949	501(c)(3)	$5,000	Support for free medical and dental care for patients in need
New Hampshire Hospital Association
125 Airport Road	Concord	NH	03301	026012527	501(c)(6)	$111,460	Funding to enhance and support the performance of New Hampshire-based hospitals

Field	Value	IRS element (for citing)
Total501c3 Org	2	Total501c3OrgCnt
Total Other Org	1	TotalOtherOrgCnt

Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp

Field	Value	IRS element (for citing)
Grant Type	Tuition Assistance	GrantTypeTxt
Recipient	12	RecipientCnt
Cash Grant	$25,207	CashGrantAmt

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	Part I, Line 2:	FormAndLineReferenceDesc
Explanation	APD provides support for selected community organizations that address needs identified in the Community Health Needs Assessment and are part of APD's Community Health Improvement plan. For this reporting period, hospital staff identified the Carter Community Building Association and Upper Valley Aquatic Center for a new program known as FitScripts. The annual amount to be contributed by APD to these organizations is approved annually through the annual budget process. APD receives and reviews each year the organizations' published annual reports and also maintains informal contacts throughout the year to monitor the organizations' operations and services. Additionally, the Hospital provides tuition reimbursement for some health professional employees. The employees must have been employed by the Hospital or a related entity for at least one year and be in good standing.	ExplanationTxt

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Compensation Committee	Yes (X)	CompensationCommitteeInd
Independent Consultant	Yes (X)	IndependentConsultantInd
Compensation Survey	Yes (X)	CompensationSurveyInd
Board Or Committee Approval	Yes (X)	BoardOrCommitteeApprovalInd
Severance Payment	Yes (1)	SeverancePaymentInd
Supplemental Nonqual Rtr Plan	Yes (1)	SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm	0	EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org	0	CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs	0	CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org	0	CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs	0	CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments	Yes (1)	AnyNonFixedPaymentsInd
Initial Contract Exception	0	InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (17 entries)

TitleTitleTxt	Base Compensation Filing OrgBaseCompensationFilingOrgAmt	Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt	Bonus Filing OrganizationBonusFilingOrganizationAmount	Bonus Related OrganizationsBonusRelatedOrganizationsAmt	Other Compensation Filing OrgOtherCompensationFilingOrgAmt	Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt	Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt	Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt	Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt	Total Compensation Filing OrgTotalCompensationFilingOrgAmt	Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt	Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
George T Blike
Trustee	$0	$420,653	$0	$5,250	$0	$62,551	$0	$52,781	$0	$36,528	$0	$577,763	$0	$0
John P Houde MD
Trustee; Orthopaedic Surgeon	$486,460	$0	$5,500	$0	$24,500	$0	$5,500	$0	$41,938	$0	$563,898	$0	$0	$0
Patrick F Jordan
Trustee	$0	$593,350	$0	$250	$0	$1,588	$0	$21,080	$0	$37,284	$0	$653,552	$0	$0
Edward J Merrens
Trustee (end 12/18)	$0	$629,398	$0	$10,250	$0	$70,908	$0	$28,864	$0	$20,070	$0	$759,490	$0	$0
Tina E Naimie
Trustee	$0	$256,492	$0	$250	$0	$557	$0	$19,498	$0	$9,093	$0	$285,890	$0	$0
Mary M Oseid
Trustee	$0	$257,606	$0	$250	$0	$19,030	$0	$37,819	$0	$22,440	$0	$337,145	$0	$0
Scott W Rodi
Trustee	$0	$331,782	$0	$250	$0	$414	$0	$24,846	$0	$35,528	$0	$392,820	$0	$0
Susan E Mooney MD MS
President & CEO	$300,084	$26,094	$72,222	$6,280	$22,540	$1,960	$22,080	$1,920	$35,169	$3,058	$452,095	$39,312	$0	$0
Randall D Lea MD MPH
VP/Chief Medical Officer (end 8/18)	$129,765	$0	$16,310	$0	$6,456	$0	$3,228	$0	$20,456	$0	$176,215	$0	$0	$0
Brenda L Blair
VP & COO	$180,594	$0	$22,793	$0	$4,921	$0	$1,968	$0	$26,123	$0	$236,399	$0	$0	$0
Timothy Graham MBA FHFMA CPA
Interim CFO (end 1/19)	$207,000	$51,750	$0	$0	$23,762	$5,940	$0	$0	$0	$0	$230,762	$57,690	$0	$0
Kathryn M Vargo MD
Medical Staff President	$150,606	$0	$388	$0	$21,703	$0	$3,617	$0	$36,872	$0	$213,186	$0	$0	$0
Ivan Tomek MD
Orthopaedic Surgeon	$511,741	$0	$4,500	$0	$24,500	$0	$23,000	$0	$35,401	$0	$599,142	$0	$0	$0
Dale C Vidal MD MS
Exec. Dir., Multi-Specialty Clinic	$475,304	$0	$17,793	$0	$24,500	$0	$5,500	$0	$41,335	$0	$564,432	$0	$0	$0
Leonard M Rudolf MD
Orthopaedic Surgeon	$452,141	$0	$0	$0	$24,500	$0	$5,500	$0	$23,993	$0	$506,134	$0	$0	$0
Paul Sansone MD
Anesthesiologist	$418,708	$0	$250	$0	$13,250	$0	$5,500	$0	$35,172	$0	$472,880	$0	$0	$0
Diane C Riley MD
Orthopaedic Surgeon	$411,704	$0	$4,500	$0	$24,500	$0	$5,500	$0	$29,124	$0	$475,328	$0	$0	$0

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Part I, Lines 4a-b	The following individuals had an actuarial change in pension value during the year reported in Schedule J, Part II, Column C: Edward J. Merrens, MD - $2,284 George Blike - $26,201 Mary Oseid - $11,239 All amounts reported in Column C will be included as part of taxable wages in the employees' Form W-2 when paid out. An eligible employee is a participant in the Dartmouth-Hitchcock retirement plan and/or any prior pension arrangements sponsored by Dartmouth-Hitchcock (including a qualified defined benefit plan) who would be entitled to additional contributions or benefit accruals under the terms of the plans for the plan year, but are limited by IRC Section 401(a)(17) and/or 415. For eligible employees, the employer will pay the eligible employee an amount determined by the employer each year to offset the amount of the reduction in the benefit accrual or contributions as a result of limitations imposed by IRC Sections 401(a)(17) and/or 415. Schedule J, Part II, Column B, Parts (i), (ii), and (iii) represent actual amounts paid to employees by Alice Peck Day Memorial Hospital or Dartmouth-Hitchcock. These amounts are reported to employees on their annual Form W-2 as compensation. Columns C and D represent items earned, however, not paid directly to the employee as cash payments during the calendar year. Column C includes retirement benefits as well as any changes in pension actuarial value (if applicable) in a calendar year. Column D represents nontaxable benefits such as the cost of healthcare coverage sponsored by the Organization or a related organization.
Part I, Line 7	A portion of compensation to certain employees is at-risk and variable, and payment depends on the quality of job performance.
Form 990, Part VII-A, Line 5:	During the fiscal year, Alice Peck Day Memorial Hospital had an interim CFO, Timothy Graham through January 2019. Mr. Graham was compensated through a consulting firm, Healthcare RESQ, LLC, during the calendar year. The total amount paid to Healthcare RESQ, LLC for his services was $258,750. Mr. Graham was directly compensated an additional $29,702 to cover travel expenses. Alice Peck Day Memorial Hospital had an interim CFO, Christopher Fallon from January 2019 through June 2019. The amounts of Graham's compensation allocated as specific to the filing organization are broken out in Form 990, Part VII. The total amounts allocated to each related organization are also codified in Part VII. Fallon did not receive any compensation in calendar year 2018. Therefore, in accordance with IRS Instructions for Form 990, no amount of the compensation paid to Fallon has been reported on the filing organization's Form 990, Part VII.

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd

Issuer Name IssuerName

Field	Value	IRS element (for citing)
Business Name Line1	NH Health and Education Facilities Authority	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Bond Issuer EIN	020279866	BondIssuerEIN
Bond Issued	2018-08-15	BondIssuedDt
Issue Price	$25,865,000	IssuePriceAmt
Purpose	Refund bond issued 11/30/2010	PurposeDesc
Defeased	0	DefeasedInd
On Behalf Of Issuer	0	OnBehalfOfIssuerInd
Pool Financing	0	PoolFinancingInd

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Total Proceeds	$25,865,000	TotalProceedsAmt
Issuance Costs From Proceeds	$289,249	IssuanceCostsFromProceedsAmt
Other Spent Proceeds	$25,575,751	OtherSpentProceedsAmt
Substantial Completion	2018	SubstantialCompletionYr
Refunding Tax Exempt Bonds	Yes (1)	RefundingTaxExemptBondsInd
Refunding Taxable Bonds	0	RefundingTaxableBondsInd
Final Allocation Made	Yes (1)	FinalAllocationMadeInd
Adequate Books And Rec Maint	Yes (1)	AdequateBooksAndRecMaintInd

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Owning Bond Financed Property	0	OwningBondFinancedPropertyInd
Any Lease Arrangements	Yes (1)	AnyLeaseArrangementsInd
Mgmt Contract Bond Fincd Prop	Yes (1)	MgmtContractBondFincdPropInd
Engage Bond Counsel Contracts	Yes (1)	EngageBondCounselContractsInd
Any Research Agreements	0	AnyResearchAgreementsInd
Private Bus Use By Others	0.00500	PrivateBusUseByOthersPct
Private Bus Concerning UBI	0.00000	PrivateBusConcerningUBIPct
Total Private Business Use	0.00500	TotalPrivateBusinessUsePct
Bond Iss Meet Prvt Sec Pymt Test	0	BondIssMeetPrvtSecPymtTestInd
Change In Use Bond Financed Prop	0	ChangeInUseBondFinancedPropInd
Procs Nonqualified Bond Remdtd	Yes (1)	ProcsNonqualifiedBondRemdtdInd

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Form8038 T Filed	0	Form8038TFiledInd
Rebate Not Due Yet	Yes (1)	RebateNotDueYetInd
Exception To Rebate	0	ExceptionToRebateInd
No Rebate Due	0	NoRebateDueInd
Variable Rate Issue	0	VariableRateIssueInd
Hedge Identified In Bks And Rec	0	HedgeIdentifiedInBksAndRecInd
Gross Proceeds Invested In GIC	0	GrossProceedsInvestedInGICInd
Gross Proceeds Invested	0	GrossProceedsInvestedInd
Written Proc To Monitor Reqs	Yes (1)	WrittenProcToMonitorReqsInd

Procedures Corrective Action ProceduresCorrectiveActionGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Procedures Corrective Action	Yes (1)	ProceduresCorrectiveActionInd

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	Form 990, Schedule K, Part II, Column A, Line 11:	FormAndLineReferenceDesc
Explanation	The other spent proceeds are the refunding proceeds of the issue that are no longer in escrow.	ExplanationTxt

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (2 entries)

Relationship DescriptionRelationshipDescriptionTxt	TransactionTransactionAmt	TransactionTransactionDesc	Sharing Of RevenuesSharingOfRevenuesInd
Timothy Graham MBA FHFMA CPA
Chief Financial Officer	$288,452	During the fiscal year, Alice Peck Day Memorial Hospital had an interim CFO, Timothy Graham through January 2019. Mr. Graham was compensated through a consulting firm, Healthcare RESQ, LLC, during the calendar year. The total amount paid to Healthcare RESQ, LLC for his services was $258,750. Mr. Graham was directly compensated an additional $29,702 to cover travel expenses. These totals represent payment for services to Alice Peck Day Memorial Hospital and Alice Peck Day Lifecare Center. All transactions were at arm's length. The amounts allocated as specific to the filing organization are broken out in Form 990, Part VII. The total amount paid to Healthcare RESQ, LLC for Mr. Graham's services to the entire APD system has been reported in Schedule L, Part IV, Column (c).	0
Jennifer Sage Schiffman
Trustee	$26,506	Jennifer Sage Schiffman serves as a trustee on the Hospital's board of directors. Jennifer's husband holds an ownership interest in the entity Nomad Communications, which provides publication and communication services. During the tax filing period, the Hospital contracted with Nomad Communications for professional marketing services. This was part of an on-going arrangement, and the rates paid by the Hospital were agreed upon at fair market value.	0

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (14 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Form 990, Part III, line 3	Effective July 1, 2018, Alice Peck Day Memorial Hospital, an affiliate of Dartmouth-Hitchcock Health (D-HH), became the sole corporate member of the Alice Peck Day Lifecare Center. As such, the Lifecare Center became an affiliate of D-HH, which constituted a change in control at the Lifecare Center.
Form 990, Part V, Line 1a & 2a:	For administrative purposes, Alice Peck Day Memorial Hospital acts as the common paymaster for Alice Peck Day Lifecare Center, Inc.
Form 990, Part VI, Section A, line 3	During the fiscal year, Alice Peck Day Memorial Hospital had an interim CFO, Timothy Graham through January 2019. Mr. Graham was compensated through a consulting firm, Healthcare RESQ, LLC, during the calendar year. The total amount paid to Healthcare RESQ, LLC for his services was $258,750. Mr. Graham was directly compensated an additional $29,702 to cover travel expenses. Alice Peck Day Memorial Hospital had an interim CFO, Christopher Fallon from January 2019 through June 2019. The amounts of Mr. Graham's compensation allocated as specific to the filing organization are broken out in Form 990, Part VII. The total amounts allocated to each related organization are also codified in Part VII. Mr. Fallon did not receive any compensation in calendar year 2018 from the Hospital or its affiliates as his tenure did not begin until 2019. Therefore, in accordance with IRS Instructions for Form 990, no amount of the compensation paid to Fallon has been reported on the filing organization's Form 990, Part VII. Compensation information for Mr. Fallon will be reported on the Hospital's 2019 Form 990 for fiscal year ending June 30, 2020.
Form 990, Part VI, Section A, line 6	The Membership of the Corporation shall consist of Dartmouth-Hitchcock Health (D-HH) as the sole member.
Form 990, Part VI, Section A, line 7a	The Member will retain the reserved power to appoint without limitation one-third of the Trustees (which appointees, before final appointment by Member, will be discussed with the Board Chair and other Trustees selected by the Chair for their input). The D-H/D-HH CEO or designee will serve on the Board ex officio, with full voting rights, and will count toward the one-third membership appointed by Member.
Form 990, Part VI, Section A, line 7b	The Member will retain the following reserved powers over APD, which, except as otherwise required below, will be exercised by the D-HH Board of Trustees or the D-HH CEO, as determined by the D-HH Board of Trustees: 1. To initiate and/or to approve or disapprove all material governance, programmatic, and financial decisions of the Board of Trustees, including without limitation the elimination or addition of any material health/health care services or programs; 2. To appoint without limitation one-third of the Trustees (which appointees, before final appointment by Member, will be discussed with the Board Chair and other Trustees selected by the Chair for their input). The D-H/D-HH CEO or designee will serve on the Board ex officio, with full voting rights, and will count toward the one-third membership appointed by Member; 3. To ratify those trustee candidates nominated by the Board in accordance with Section 2.04 of the Corporation's bylaws (meaning the ability of Member to approve or disapprove, based on a good faith and reasonableness standard, each trustee candidate nominated by the Board of Trustees and upon such approval, the ability to install such approved candidate to the Board); 4. To remove by a vote of two-thirds of the D-HH Board of Trustees any Trustee if the Member determines in its reasonable good faith discretion that such removal is in the best interests of the D-H System which will include APD and taking into consideration the impact on APD and the community it serves, following prior consultation with the Board Chair; 5. To approve of borrowings (debt) and dispositions of material assets by APD; 6. To approve any key strategic relationship(s) between APD and another organization(s) (key strategic relationships defined as the ownership or contractual participation in a network, system, affiliation, joint venture, alliance or similar arrangement with an organization that is not part of the D-H System or which is not addressed in a Member approved APD strategic plan); 7. To initiate and/or to approve all operating and capital budgets as well as all strategic plans of APD; 8. To approve all policies relating to academic and research programs and affiliations; 9. To allocate the non-donor restricted assets and resources of APD and D-H/D-HH as appropriate to serve the overall best interests of the D-H System (which will include APD), taking into consideration the impact on APD and the community it serves; while Member will retain this reserved power, Member will exercise this reserved power only after consulting with and providing reasonable time and opportunity for the Board of Trustees to provide meaningful input and recommendations which shall be considered in good faith. For one (1) year following the effective date of its bylaws any material reallocation of assets or resources will also require an affirmative vote by a majority of the Board of Trustees. 10. Except as limited by the affiliation agreement, to appoint, evaluate the performance of, and terminate the APD President and CEO, subject to prior consultation with the Board of Trustees and a reasonable time and opportunity for the Board to provide meaningful input and recommendations which shall be considered in good faith. 11. To approve any proposed amendment or repeal of the APD articles of agreement or bylaws which proposed amendment or repeal would (i) impact the powers reserved to Member in its bylaws, or (ii) reasonably be expected to have any material strategic, competitive or financial impact on the D-H System. No change in the provisions of APD's bylaws shall be binding on D-H/D-HH or APD unless such change(s) is/are approved by way of amendment to APD's governing documents approved by Member. 12. To approve the dissolution or liquidation of APD, following such approval by the Board.
Form 990, Part VI, Section B, line 11b	Management provides a notice that the completed Form 990 is available to the Finance Committee prior to filing. Management advises the Finance Committee that the completed Form 990 is available on a secure website that requires an assigned user name and password. The Chair of the Finance Committee advises the Financial Committee members to review the Form 990 for content and raise any issues with Board Leadership or Management. The Chair of the Finance Committee advises the Chair of the Board and the full Board that the Form 990 is available for review. That notice is in advance of the filing deadline to enable a detailed and conscientious review by the Board. All questions and concerns are addressed by the Chief Executive Officer and are incorporated into the Form 990 as deemed appropriate. Management files the final Form 990 with the Internal Revenue Service, as required after the above review is concluded.
Form 990, Part VI, Section B, line 12c	Alice Peck Day has a multi-faceted conflict of interest policy. Members of the Board of Trustees complete conflict of interest questionnaires on an annual basis and any new members complete the questionnaire upon joining the Board. As part of our ongoing monitoring process, our Executive Assistant reviews all Board questionnaires and disclosures to identify any potential conflicts before they arise. In addition, our Executive Assistant attends all Board meetings to ensure that if any conflicts arise, they are handled appropriately. If such conflicts arise, the Organization complies with the New Hampshire and federal requirements for disclosures of such events. The Organization is committed to conducting its business in a manner that is both ethical and legal. As part of this commitment, a standard of conduct form is required of all employees of the organization. This is reviewed with all employees upon hire and on an annual basis thereafter. The standard of conduct covers conflict of interest and other vital matters to ensure all business activity is conducted in a manner that is consistent with the highest standards of honesty, integrity, and fairness.
Form 990, Part VI, Section B, line 15	The Human Resources Committee of the Alice Peck Day Memorial Hospital Board of Trustees is responsible for determining the compensation of the Chief Executive Officer/President. The Chief Administrative Officer or her designee provides compensation data of comparable organizations with approximately the same size staff and spending in a location of similar size. The committee determines the appropriate compensation and approves an amount that is then communicated to Human Resources for adjustment. Dartmouth-Hitchcock Health reviews the compensation of the CEO/President in addition to the process described above. The CEO/President is responsible for reviewing the performance of senior management staff. The information is brought to the Human Resource Committee of the Board of Trustees along with a recommendation for the salary of each individual. The compensation is determined through a variety of analysis of salary data and performance. Individual salary increases are then based on overall performance, within budgeted increases for the organization. The Human Resources committee approves the base compensation and salary increase amount.
Form 990, Part VI, Section C, line 19	The Organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon request.
Form 990, Part VII, Section A, Column D:	Dr. Susan E. Mooney is a practicing physician in addition to being the Chief Executive Officer. She worked an average of 61 hours per week, of which a majority of time is spent on executive matters. Approximately 8 hours per month is spent as a physician.
Form 990, Part XI, line 9:	Net assets transferred from affiliates 8,377,459.
Form 990, Part XII, Line 2c:	The finance committee acts as the audit committee and oversees the audit process for the Alice Peck Day entities. Independent accountants performed the audit for the fiscal year ended 6/30/19. For the fiscal year ended 6/30/19 the Hospital was included in the Dartmouth Hitchcock Health System consolidated audited statements.
Form 990, Part XII, Line 3a:	Alice Peck Day Memorial Hospital was included in the consolidated audited financial statements of the Dartmouth-Hitchcock Health System. During fiscal year 2019, Mary Hitchcock Memorial Hospital expended federal funding which met the minimum threshold set forth in the single audit act and OMB Circular A-133. Due to the nature of the consolidated financial statements, the audit was performed on the financial information of all organizations, including Alice Peck Day Memorial Hospital.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (8 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Exempt Code SectionExemptCodeSectionTxt	Public Charity StatusPublicCharityStatusTxt	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt	Controlled OrganizationControlledOrganizationInd	Direct Controlling NADirectControllingNACd
Alice Peck Day Lifecare Center Inc
10 Alice Peck Day Drive	Lebanon	NH	03766	020479094	Independent & Assisted Living	NH	501(c)(3)	Line 10	APD Memorial Hospital	Yes (1)
Alice Peck Day Realty Corp
10 Alice Peck Day Drive	Lebanon	NH	03766	020485369	Inactive	NH	501(c)(2)		APD Memorial Hospital	Yes (1)
Dartmouth-Hitchcock Health
One Medical Center Drive	Lebanon	NH	03756	264812335	Govern Integrated Health System	NH	501(c)(3)	Line 7		0	N/A
Dartmouth-Hitchcock Clinic
One Medical Center Drive	Lebanon	NH	03756	222519596	Physician Services	NH	501(c)(3)	Line 10	Dartmouth-Hitchcock Health	0
Mary Hitchcock Memorial Hospital
One Medical Center Drive	Lebanon	NH	03756	020222140	Hospital	NH	501(c)(3)	Line 3	Dartmouth-Hitchcock Health	0
The New London Hospital Association Inc
273 County Road	New London	NH	03257	020222171	Hospital	NH	501(c)(3)	Line 3	Dartmouth-Hitchcock Health	0
Windsor Hospital Corporation
289 Country Road	Windsor	VT	05089	030183721	Hospital	VT	501(c)(3)	Line 3	Dartmouth-Hitchcock Health	0
Cheshire Medical Center
580 Court Street	Keene	NH	03431	020354549	Hospital	NH	501(c)(3)	Line 3	Dartmouth-Hitchcock Health	0

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp

Related Organization Name RelatedOrganizationName

Field	Value	IRS element (for citing)
Business Name Line1	OneCare VT ACO LLC	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	111 Colchester Avenue	AddressLine1Txt
City	Burlington	CityNm
State Abbreviation	VT	StateAbbreviationCd
ZIP	05401	ZIPCd

Field	Value	IRS element (for citing)
EIN	455399218	EIN
Primary Activities	Shared Saving	PrimaryActivitiesTxt
Legal Domicile State	VT	LegalDomicileStateCd
Direct Controlling NA	N/A	DirectControllingNACd

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (3 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Direct Controlling NADirectControllingNACd	Entity TypeEntityTypeTxt	Controlled OrganizationControlledOrganizationInd
Alice Peck Day Health Management Corp
10 Alice Peck Day Drive	Lebanon	NH	03766	020485370	Inactive	NH	N/A	C	0
Hitchcock Health Connect
One Medical Center Drive	Lebanon	NH	03756	800908979	Telehealth	DE	N/A	C	0
Imaginecare Inc
One Medical Center Drive	Lebanon	NH	03756	813105071	Software Tech	NH	N/A	C	0

Field	Value	IRS element (for citing)
Receipt Of Int Annts Rnts Rylts	0	ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org	0	GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org	0	GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org	0	LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org	0	LoansOrGuaranteesFromOthOrgInd
Div Related Organization	0	DivRelatedOrganizationInd
Asset Sale To Other Org	0	AssetSaleToOtherOrgInd
Asset Purchase From Other Org	0	AssetPurchaseFromOtherOrgInd
Asset Exchange	0	AssetExchangeInd
Rental Of Facilities To Oth Org	0	RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org	0	RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org	0	PerformOfServicesForOthOrgInd
Perform Of Services By Other Org	0	PerformOfServicesByOtherOrgInd
Sharing Of Facilities	0	SharingOfFacilitiesInd
Paid Employees Sharing	Yes (1)	PaidEmployeesSharingInd
Reimbursement Paid To Other Org	Yes (1)	ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org	Yes (1)	ReimbursementPaidByOtherOrgInd
Transfer To Other Org	Yes (1)	TransferToOtherOrgInd
Transfer From Other Org	Yes (1)	TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp

Other Organization Name OtherOrganizationName

Field	Value	IRS element (for citing)
Business Name Line1	Alice Peck Day Lifecare Center	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Transaction Type	S	TransactionTypeTxt
Involved	$382,657	InvolvedAmt
Method Of Amount Determination	Actual per books	MethodOfAmountDeterminationTxt